Role of inotropic agents in the treatment of heart failure.

Systolic heart failure (HF) is a systemic disease caused by reduced cardiac contractility. Although it would seem logical that this disease could be treated with strategies to directly improve contractility, inotropic therapies in the HF population have universally failed to live up to their expectations. Paradoxically, favorable outcomes can be achieved by administering drugs that may transiently reduce contractility while blocking neurohormonal stimulation. The proven success of this latter approach, especially in combination with implantable cardioverter-defibrillator and cardiac resynchronization therapy, has drawn our attention away from addressing the root cause of the problem: reduced contractility. In this clinician update, we discuss current options for inotropic therapy in HF, when it might be appropriate to use inotropes in HF patients, and what steps can be taken to mitigate their risks while maximizing benefit.